Ellie Hawk

Compare/Contrast Activity
Research I
Part I: Trade Publication Article
Trade magazine articles are an informal type of publication. These publications are to
inform broad audiences with informal, journalistic writing.1 Publications in these trade
magazines are written by staff or contract writers, in which they are paid for their work. The
articles are typically available for free and online due to various job postings and advertisements
within the magazines. Although the trade magazine articles are informal by containing various
types of information, their purpose is still to inform and educate. They may lack credibility
verses peer reviewed articles, but still are great tools to enlighten individuals about possible new
advancements, developments or other happenings within the field.
I found an article from the January 2015 Radiology Today trade magazine that sparked by
interest. Orenstein2 wrote the article about reducing PET scan dose. This article was interesting
to me since many times patients will receive a PET scan or PET/CT scan before treatment. As
Medical Dosimetrists, or medical dosimetry students, we see these frequently and work off the
scans data to develop unique treatment plans for patients. As we know, when patients receive a
PET scan they receive a dose of radiation. This dose is even greater when it is a PET/CT scan
that is performed, which is pretty common. I was interested in this article and how to reduce PET
dose due to the fact of wanting to spare patients from as much radiation as possible before,
during and after their treatment.
This article elaborates how much emphasis has been placed on reducing radiation doe
from CT exams.2 Within the article Philips Healthcare radiation health and safety officer

mentions, PET scans and PET/CT can expose patients to even more ionizing radiation than CT
alone. Yet dose reduction in PET, included PET/CT, does not get nearly as much attention.2 PET
has not received as much attention due to lack of publicized issues, like CT, along with the PET
scan industry. The industry is to blame for PET scans having two vendors working together from
differing industries. One vendor develops the cameras while another the radiopharmaceuticals
given to patients. These two industries and vendors have different regulation agencies in which
development of regulations and protocols becomes challenging. The advancements necessary to
help reduce PET dose were discussed from both the camera and radiopharmaceutical point of
view. Versions of modern hardware and softwares were discussed throughout the article, which
take the different advancements into account and are actively reducing PET dose.
Many strengths and weakness were presented within this article. A strength of the article
were the sources used. Many creditable sources were used from leading vendors in the field such
as Philips Healthcares radiation and safety officer, GEs molecular imaging and CT dose leader,
and Toshiba America Medical Systems CT business senior manager. Other very respectful
sources were cited such as the biophysicist at the Mayo Clinic, prior radiation oncologists, and
associate professor of radiology at the University of Tennessee. These individuals have great
knowledge and experience in the field giving substance, experience, and credibility to the article.
Another strength was the detail of steps necessary to move forward in reducing PET dose. These
include increasing sensitivity of the camera, and reduction of radiopharmaceutical dose. The
ways to achieve these were described in detail, along with the potential challenges taking these
steps could create for PET scans. Many advancements were discussed that are currently used
within departments, but the more modern advancements that were showcased at RSNA in
November seemed to lack their projection on the market. I found myself wondering if these

machines will be something I will be working with once completing the program and find this to
be a weakness within the article. Is the technology still a work in progress with advancements to
the technology still to be made? Or will these machines become the standard within departments
within the near future?
This article in all was extremely useful to me, and insightful. I feel the article would not
only be helpful those working within radiation therapy departments, but to those in all imaging
departments. I even feel this article would be beneficial to general public so that they understand
the radioactivity of PET scans and advancements in progress for their safety.

References
1. Lenards N, Weege M. Radiation Therapy and Medical Dosimetry Reading. [Powerpoint]. La
Crosse, WI: UW-L Medical Dosimetry Program; 2015.
2. Orenstein B. Reducing PET Dose. Radiology Today.
http://www.radiologytoday.net/archive/rt0115p22.shtml. Published January 2015. Accessed
March 24, 2015.

Part II: Peer Reviewed Journal Article

In comparison to the informal trade magazine articles, there are peer reviewed research
articles. These articles are more prestigious for publications and reviewers must okay the article
or paper before allowing it to be published.1 A group of professionals work together as authors
of the article. Together they collaborate to present and describe a problem or hypothesis. The
articles information is divided into subsections of abstract, introduction, methods, results,
discussion, conclusion, and references. Each of these subsections has structure of information
that should, and is, included for a structured and organized article for readers.
The peer reviewed article I found interesting was the Effect of CT contrast on volumetric
arc therapy planning (RapidArc and helical tomotherapy) for head and neck cancer. This article
was written by the Department of Radiation Oncology and Department of Radiation Physics at
the City of Hope National Medical Center in Duarte, CA. Liu et al2 collaborated to develop this
informative article about CT contrast effect on volumetric arc therapy (VMAT) planning. A
problem was presented concerning if the presence of CT contrast within a head or neck would
affect dose delivery within a patient.
Within the introduction background information was explained as to why this was a
problem to evaluate. Due to contrast changing Hounsfield units (HU) within a scan, this caused
the speculation as to if dose would be affected. From this speculation a research design was
developed and carried out. A test group of 5 patients with head and neck cancer were used.
Initially these patients received a CT scan without contrast in which a treatment plan was
developed in both helical tomotherapy and Varian RapidArc. Next, the patients received CT
contrast and another CT scan. These scans were then sent to be planned in helical tomotherapy

and Varian RapidArc. Upon development of helical tomotherapy and RapidArc plans for noncontrast and contrast CT scans, the results were ready to be compared.
As explained and expected, the CT with contrast media had increased HU. The increases
are displayed on tables within the article. The range of HU increase from 5 to 36. The largest
increase occurring in the parotid region presumably to the concentration of blood flow.2 Besides
HU change, the electron density was also varied. This only occurred due to contrast presence, not
patient electron density changes.2 Evaluation of organ and critical structure dose were evaluated
using the dose volume histogram (DVH). Majority of the point doses in plans based on
postcontrast images had lower dose than the plans without contrast.2 Although variations were
observed between noncontrast and contrasted CT scans used in treatment planning, they did not
differ more than 2%.2 Upon the results displaying a miniscule 2% difference between dose
distribution a conclusion was drawn. First off, it was determined that 2% dose difference is so
small that it would not make a clinical difference. Due to no clinical difference being noticed, a
decision was made to eliminate the noncontrast CT scan that is performed prior to the CT scan. It
is deemed not necessary to re-expose the patient to obtain 2 scans. In conclusion only contrasted
CT scans are performed for head and neck cancers for helical tomography and RapidArc plans.
I found this article and its research to be informative, yet repetitive. It was very well
written and organized in a fashion that was easy to follow and understand the steps. I did feel
some of the information presented was redundant or even obvious that was mentioned. The
conclusion developed was protecting of the patient exposure levels while also time consuming
for department staff in which I found appealing.

References
1. Lenards N, Weege M. Radiation Therapy and Medical Dosimetry Reading. [Powerpoint]. La
Crosse, WI: UW-L Medical Dosimetry Program; 2015.
2. Liu A, Vora N, Suh S, Liu A, Schultheiss T, Wong J. Effect of CT contrast on volumetric arc
therapy planning (RapidArc and helical tomotherapy) for head and neck cancers. Med Dosim.
2015;40(1):32-36. http://dx.doi.org/10.1016/j.meddos.2014.07.003